After starting my pediatric mental health company in 2021, one of our first patients was a child referred to us from the emergency room (ER) after a deeply disturbing experience in the health care system. She was given medication by her primary care physician (PCP) to help her cope with the emotional struggles of her divorce, but when the initial dose didn’t work, her doctor kept increasing it. Over time, she developed serious side effects, including self-injurious behaviors such as hair pulling. Desperate for help, her mother begged her PCP to take her off the medication, but the provider did not know how to safely lower the dose.
They went to the ER in a panic, but the ER is not equipped to handle complex medication adjustments like this. It’s not something they do. The PCP sent the family to the ER for help, but the ER sent them back. It left the mother devastated, stuck in a system no one could help or educate.
Unfortunately, this story is all too common. Providers often prescribe psychiatric medications without adequate training, relying on research rather than clinical experience. It’s like trying to treat chest pain by prescribing heart medication without consulting a cardiologist first. You can’t manage an arrhythmia without specialist involvement, but we see this approach all the time in mental health care.
But that’s not the PCP’s fault—they’re not set up to handle mental health crises. However, a lack of cooperation and expertise in these situations has devastating consequences for families. It’s a glaring symptom of a larger crisis: the youth mental health epidemic.
The alarming state of youth mental health
According to the Centers for Disease Control and Prevention (CDC), suicide rates among children and youth increased 62% between 2007 and 2021, with social media platforms contributing to feelings of inadequacy, isolation, and hopelessness. This alarming trend reflects a wider crisis: between 2016 and 2020, 5.6 million children and adolescents were diagnosed with anxiety and 2.4 million with depression.
While these numbers predate the pandemic, the crisis has deepened in recent years, especially among teenage girls who face increased social pressures, academic stress and the pervasive influence of social media. In 2023, 73% of adolescent girls reported at least one mental health problem, with nearly half (48%) experiencing comorbid conditions.
Unjust burden of pediatricians
The mental health crisis in young people is not only staggering in numbers, it is evident every day in children’s clinics. With 74% of US states lacking child psychiatrists, unregistered pediatricians are now on the front lines of managing mental health care because other mental health services are either full or unavailable. These doctors are sworn to care for their patients, but are often asked to treat mental health conditions with inadequate resources and training.
It’s not their fault. The economics of mental health care in this country make it difficult to provide accessible, effective treatment, and a shortage of psychiatric doctors only adds to the burden. The reality is that primary care providers are doing their best in a broken system that doesn’t give them the tools or support to succeed.
Consider this: despite black box warnings about increased suicidal thoughts and behaviors, less than 5% of pediatric patients are followed up with black box warnings according to the FDA’s recommended schedule for antidepressants. Meanwhile, antidepressant prescriptions among children aged 5-12 increased by more than 40% from 2015 to 2021. These drugs are powerful, and prescribing them without therapy or close monitoring puts children at risk.
Pediatricians are trying to do right by their patients, but the current system is failing them. They need a model that supports them, eases the burden and ensures that the children are properly cared for.
Working for shared care
Collaborative care offers a solution that requires more attention. It’s a model that exists but is not widely implemented due to state regulations, reimbursement barriers, and provider shortages. By integrating psychiatry and therapy into primary care, collaborative care makes the most of limited resources and ensures that children receive comprehensive, evidence-based treatment.
How it works: Pediatricians oversee a medical home, supported by psychiatrists who provide guidance on medications, dosages and side effects. Therapists work with families to develop coping skills and address underlying issues. Together, these professionals create a comprehensive care plan that meets the child’s physical and mental health needs.
With the youth mental health crisis overwhelming existing systems, collaborative care expands the reach of limited psychiatric resources and empowers pediatricians to provide informed, effective care. It’s a model that just makes sense.
Build a better system
Pediatricians should not shoulder the burden of youth mental health alone. The crisis they face in their clinics is symptomatic of a larger systemic failure — one that can only be addressed by breaking down the silos between primary care, psychiatry and therapy.
A psychiatric emergency is an example of what is possible. It provides immediate, specialized support to children in crisis, bridging the gap between crisis care and long-term treatment. But for these models to succeed, they need to seamlessly link with primary care and provide ongoing, coordinated support for children and families.
We also need changes in policy and compensation. Shared care must be paid consistently in all states, including Medicaid. Without systemic support, even the best models cannot scale to meet demand.
The way forward
It’s time to recognize mental health as an integral part of overall well-being. This means equipping pediatricians with the tools and training they need, supporting them with psychiatric expertise, and fostering strong partnerships between care teams.
The youth mental health crisis is real, but not insurmountable. By embracing shared care and removing the barriers to its widespread adoption, we can build a system that truly supports children, families and their care providers.
As a child and adolescent psychiatrist, I urge politicians, health leaders and communities to take action. It’s not just about fixing a broken system, it’s about creating a new system that gives every child a chance to thrive.
Monica Roots, MD is a child and adolescent psychiatrist, co-founder, president and chief medical officer. Bending Health.